Iran Red Crescent Med J. 2017 April; 19(4):e42645.

Published online 2017 February 13.

doi: 10.5812/ircmj.42645.

Letter

Painless Stings of Yellow Iranian Scorpions

Hossein Sanaei-Zadeh1,*1Associate Professor, Emergency Room, Division of Medical Toxicology, Hazrat Ali-Asghar (p) Hospital, Shiraz University of Medical Sciences, Shiraz, Iran

*Corresponding author: Hossein Sanaei-Zadeh, Associate Professor, Emergency Room, Division of Medical Toxicology, Hazrat Ali-Asghar (p) Hospital, Meshkinfam Street7143918796, Shiraz University of Medical Sciences, Shiraz, Iran. Tel: +98-7132288604, Fax: +98-7132288907, E-mail: sanaeizadeh@sums.ac.ir

Received 2016 September 28; Revised 2017 January 15; Accepted 2017 February 05.

Keywords: Painless Sting, Iranian, Yellow Scorpions, Hemiscorpius lepturus, Hemiscorpius acanthocercus

Dear Editor,With great interest, I read the letter to the editor by Az-

izi et al., recently published in your journal (1). The authorshad compared the appearance of 2 yellow Iranian scorpionspecies, ie,Mesobuthus eupeus (Tosan) andHemiscorpius lep-turus (Gadim), and had introduced diagnostic keys to dif-ferentiate these species. Here, the question arises as towhy they had only compared these 2 species. Only 12 outof 51 scorpion species reported in Iran are medically im-portant (2-4), 7 of which are solid yellow (Figures 1 and 2).Cases stung by these species have been reported in variousprovinces of Iran with different prevalences (2).

In addition to H. lepturus species studied by Azizi et al.,H. acanthocercus found in Hormozgan province, Iran is a se-riously dangerous yellow scorpion, which is morphologi-cally identical toH. lepturus. Similar toH. lepturus, this scor-pion can cause acute renal failure and death (3). Diagno-sis of the sting of these species is important, since unlikeother yellow scorpions, their stings are painless and mightnot be considered important. Consequently, the patientsmay be discharged from the emergency department or bereferred to hospital when it is too late for anti-venom ad-ministration.

Accordingly, a special characteristic must be identifiedto differentiate these species not only from M. eupeus scor-pions, but also all other yellow scorpions which are medi-cally important in Iran. As presented in Figure 1, ordinarypeople and the majority of medical personnel (not ento-mologists) assume that they are simple solid yellow scor-pions, with a back similar to M. eupeus.

The size of scorpions is also helpful in distinguishingscorpions from one another. However, the size of matureand immature scorpions varies and is not comparable indifferent species. I believe that apart from the long tailof male H. lepturus and H. acanthocercus scorpions, theirbroad claws with dark tips distinguish them from otheryellow Iranian scorpions. This feature is distinguishablefor all individuals and health personnel and will undoubt-edly contribute to timely and accurate diagnosis.

The sting of H. lepturus and H. acanthocercus scorpionsis not common in Shiraz, the capital of Fars province, Iran.In this regard, Sagheb et al. reported 14 hospitalized pa-tients stung by H. lepturus in Namazi Hospital of Shiraz;however, they were all stung in places other than Shiraz (5).Since the establishment of the Division of Medical Toxicol-ogy in the Emergency Section of Hazrat Ali-Asghar (p) Hos-pital in July 2012 (the only adult medical toxicology centerin Shiraz) (4), we have only had 3 to 4 cases of scorpion stingby H. lepturus from villages around Darab and Borazjan inFars and Bushehr provinces; however, none of the patientshad brought the scorpion to the hospital.

Recently, during my educational toxicology roundwith medical interns, a young man was admitted with ascorpion sting; the patient had brought the scorpion tothe hospital (Figure 2). He only had a slight burning sen-sation around the sting site. At first glance, all medical in-terns recognized H. lepturus scorpion, based on the char-acteristic I had taught them. In history taking, it was re-vealed that the patient was from Ahvaz, travelling to Shiraz.Reaching inside his bag, he was stung by a scorpion whichhad sneaked into the bag in Ahvaz. The patient was hos-pitalized and managed with intravenous anti-venom ad-ministration and several urinalysis tests (6). In conclusion,painless stings of scorpions with broad claws and dark tipsshould be taken seriously.

Copyright © 2017, Iranian Red Crescent Medical Journal. This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0International License (http://creativecommons.org/licenses/by-nc/4.0/) which permits copy and redistribute the material just in noncommercial usages, provided theoriginal work is properly cited.

Sanaei-Zadeh H

Figure 1. A, MaleH.acanthocercus (image by Dr. Mehran Shahi); B, femaleH.acanthocercus (image by Dr. Mehran Shahi); C, maleH. lepturus; D, femaleH. lepturus; E,M.eupeus; F,M.caucasicus (image by Dr. Rouhullah Dehghani); G, Compsobuthus matthiesseni (image by Dr. Rouhullah Dehghani); H, Odontobuthus doriae (image by Dr. Rouhullah Dehghani);and I, Apistobuthus pterygocercus.

2 Iran Red Crescent Med J. 2017; 19(4):e42645.

Sanaei-Zadeh H

Figure 2. The Dead Male H. lepturus with Destroyed Tail Brought by the Patient

References

1. Azizi K, Akbarzadeh A, Ghobadifar MA. Yellow Scorpion Bite: Ignoreor Take it Seriously?. Iranian Red Crescent M J. 2016;18(12):919–33. doi:10.5812/ircmj.28942.

2. Dehghani R, Fathi B. Scorpion sting in Iran: A review. Toxicon.2012;60(5):919–33. doi: 10.1016/j.toxicon.2012.06.002.

3. Shahi M, Rafinejad J, Az-Khosravi L, Moosavy SH. First report of deathdue to Hemiscorpius acanthocercus envenomation in Iran: Case re-port. Electron Physician. 2015;7(5):1234–8. doi: 10.14661/1234. [PubMed:26435822].

4. Sanaei-Zadeh H, Marashi SM, Dehghani R. Epidemiological and Clini-cal Characteristics of Scorpionism in Shiraz (2012-2016); Developmentof a Clinical Severity Grading for Iranian Scorpion Envenomation.. Ac-cepted for publication in Med J Islam Repub Iran. .

5. Sagheb MM, Sharifian M, Moini M, Sharifian AH. Scorpion bite preva-lence and complications: report from a referral centre in southernIran. Trop Doct. 2012;42(2):90–1. doi: 10.1258/td.2011.110285. [PubMed:22316623].

6. Valavi E. Step by Step Treatment of Scorpion Sting in South West of Iran[in Persian]. Jundishapur Sci Med J. 2016;15(1):117–24.

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